Monday, January 4, 2010

1M Clinics: More Comments from our MMA members...

1M Clinics: More Comments from our MMA members...

Dr Choo Gim Hooi:

Today's STAR paper published a letter contributed from someone in Australia. The tone of the letter suggests that M'sian physicians are self-centred and the MOH's 1M'sia clinic should be lauded and is the way forward for M'sians.

We should tread this carefully lest our intentions are misinterpreted by the public. Such publicity would sway public opinion and MOH against us.
The letter gave example of similar clinics being run by non-physicians and are successful models of care.

Having discussed with other colleagues including Dr.Namazie - the nurse practitioners in Australia, NZ, UK,etc were very well trained through a comprehensive program. There are essentially Master graduates who have a post-basic degree trainings for a further 3-4 years. Much left to be desired in the MAs and nurses that are churned out from local training institutions. The care systems in the other countries have also been well thought of and have physicians closely associated in the whole network of care.

One has the impression that the 1 M'sia clinics have not been planned thoroughly and little thoughts of its implications on patient care and outcomes.
Just my 2 cents worth of opinion.

Dr Chan Gong Guan:
If it is true that the allocation for each 1M Clinic is only RM 30 000, then it is most probably that the 1M Clinic is just a SHOW that the Govt has put up.  The 1M Clinic will soon be forgotten and die a natural death.

However, it is a golden opportunity for MMA to gain some ground, especially in the eyes of the public.  MMA should come out with a press release, 'advise' the Govt and the Politician how to run the 1M Clinic properly, how not to waste people's money into a futile project, and of most importance, to remind them to keep up to the standard of the Healthcare Act.

I believe, that all GPs will be more than happy, to stick up that newspaper cutting in their clinic, so that it will surely reach the public widely.

To be serious, MMA, like any Citizen in this country, should be responsible enough to speak up for the sake of the country, when something is not right.

Doctors are highly respected in our community.  We must honour that respect.

Dr Subramaniam Suppiah: (via sms)
We the GPs fully support your stand on the 1Malaysia clinics.

We totally reject the government's policy of allowing HAs nd Nurses prescribing treatment to patients. It will take our health care 30 years backwards. Please ask PM to make all GP clinics to 1Malaysia clinics tro serve the poor at government cost!

Datuk Dr Sarjeet Singh Siddhu:
I somehow missed reading senior MOH FP’s post: makes it clear that even the MOH was caught unawares.

But even without it a re-read of my post (read between the lines) you will note I used words like “credible”, “persuasive” and “appears”, implying thereby that I am not convinced by the explanation. But that a simple reading of the ‘explanation’ will sound convincing to those not in the know (read as general public).

<< The question is what's next? Pls give a lot of thought to this. I am only responding to the majority's wishes to be more vocal in expressing our interests as I have been trying to do without fear or favour thus far, although personally I have more to lose than to gain. But because I have been elected to serve our members, I will do what the majority decides. >>

I agree with you there, and especially feel that we focus on “The question is what's next? Pls give a lot of thought to this”. Members are rightly agitated, but they should come up with some concrete ideas that have some hope of working’ ie something that just might make the govt see our position and act on it. In that sense I see things as follows:

  1. The odds of reversing the decision are nil (for the immediate future; ie the 50 1MCs will stay.
  2. We can only hope that the number stays at 50 (in the cities and other urban areas). The thrust of the 1MCs should be where no or very little healthcare is available.
  3. Our objection to the project must be well reasoned and presented as such in a letter to the MOH / PM
  4. We could circulate the “letter” to members and others alike, collect genuine signatures and then sign off (by the President) saying this document is supported by XXXX number of doctors. Perhaps the “signing” can be online (electronic); open a site / page that doctors can access (get some computer savvy guy to explain this; my knowledge is grossly limited).

I’m sure brighter sparks amongst us will come up with better solutions, but this is what I can figure for now. Perhaps all this discussion will lead us to the right approach.

Dato Dr Azizan Abdul Aziz:
Been following the discussion and the matter is getting sensitive and MMA has to balance the delicate situation between doctors and MOH/GOVT.

DG's tone is irritated if one disagrees with his views.As you suggest, an urgent dialogue with MOH and PM rep is essential in them trying to understand the longterm implication of their action on the medical profession.

It is sad for politicians to take advantage and gain political mileage on the 1Malaysia clinic issue.No doubt it is a good idea to address the problem of the urban poor but as everyone said ,it has to be manned by a doctor (since we uwld have surplus of doctors soon).

Dr Hooi Lai Ngoh:
Have asked some Penang members.  In general agree with Dr Ashok's views.

The government hospitals are now flooded with young doctors doing housejobs and medical officer postings.

There should be enough to put some in the clinics soon.

As for the placard demonstration the feeling is that it will be too little and too late since the first clinic will be launched next week.  We will not achieve much since it would not be possible to stop them now.  Perhaps should look into other avenues of protest and perhaps the public will support MMA when the clinics fall short of expectations.s

Prof Dr Sim Kui Hian:
Despite the fact that Sabah and Sarawak tends to get left out, by June (less than 6 months time), even Sarawak General Hospital (SGH) is going to be flooded by MO (though we are critically short in SGH the moment bcos of 2 years housemanship).  I am very sure this new MO would rather be in 1 Msia Clinic rather than sharing our noble national aspiration of national integration, get posted to the district of UK - Ulu Kapit

I understand that the number of HO in West Malaysia is a lot more that they have to do shift work!

Just to give a perspective on numbers. The whole of Sarawak normally only given 80 HO a year (in 2007 we only had 23).  Currently, SGH alone had more than 230 HO (due to 2 years HO).  So by June we will have 100 MO in SGH.  This numbers is increasingly rapidly after 2010 not only in Sarawak but in the whole country. 

SGH had 650 doctors and 230 are HO - 35% of total doctors.   Next year, if we get another 150 new HO; this means we will have 280 HO and if we take the first year MO into account, this means ~54% (280+150/800) of the doctors in SGH are less than 3 years after graduation.  There are only so many post in SGH! 

With this information, whatever MMA do, it must be perceived NOT to be
1.   Self centred (by the communities)
2.   Leadership for the young (< 3 years after graduation)

Since we all firmly believe in democracy – by next year, they can vote the senior one out of the advisory board, etc of SGH at a start and other institutions later)   

Is not just change BUT transformational change that MMA and the country never ever be seen.  It will happens in the next few years.  We need to have the courage to lead wisely.       

My Comments: (DQ)
 I agree with your sentiments about working together and all that with the MOH and for the benefits of all doctors and the community. During the first 6 months of my term, I have personally worked very hard to get along with the MOH, and we have been working together just fine, until the latest issue erupted!

You have actually brought up some very real issues such as glut of young doctors, which we all are also very concerned with . If this issue of 1Malaysia clinics continue to expand with more and more being set up because it is cheaper, what will happen to our younger doctors?

 That is why we are making such a issue, task shifting to other allied personnel will encroach onto our medical professionals, not you and me specifically but to a lot of other doctors coming in the pipeline. These are the doctors we are fighting for, so please, give concrete ideas as to how to tackle or resolve this issue. Where do we go from here?

After trying to set up a meeting with the MOH whole of last 2 weeks, finally this morning the Principal Private Secretary (Mr Lim Eng Leong) of the Minister of Health called and is trying to set up a meeting with the Minister and MOH officials, sometime this Friday, but time and place still not confirmed. I hope all GPs and many MMA members will turn up in huge force to meet with the Minister and express our unhappiness.

Just to let you know, a few of the professional bodies' presidents called me personally to support us in our quest to protect our professionalism and practice; they too are worried if some of these can be task-shifted away from them!

Will keep you all posted.


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